Alzheimer's Treatment Divide: Are We Chasing the Wrong Target?
The recent survey of neurologists regarding new Alzheimer's treatments reveals a significant divide in the medical community. While these new drugs target amyloid plaques in the brain, there's growing concern that this approach may be too little, too late in the fight against Alzheimer's disease.
The survey, conducted by Drs. Doraiswamy and Schneider, shows that opinions on prescribing new treatments like Lecanemab (Leqembi) and Donanemab (Kisunla) are split almost evenly. This division highlights a crucial point: targeting amyloid plaques might not be the most effective strategy.
Amyloid plaques are often considered a hallmark of Alzheimer's, but it's important to understand that they are a downstream finding - a result of the disease process rather than its primary cause. By the time these plaques form, significant brain damage may have already occurred.
The focus on reducing plaques once they've formed is akin to closing the barn door after the horse has bolted. What we really need is a shift towards early diagnosis and prevention. Identifying individuals at risk before symptoms appear and implementing preventive measures could be far more effective than trying to clear plaques from an already damaged brain.
Moreover, the survey reveals that only 5% of neurologists view biomarker changes (such as reductions in amyloid plaques) as a measure of clinical benefit. This statistic underscores the need to look beyond plaque reduction and focus on strategies that can prevent or slow the underlying disease process.
59% of U.S. neurologists endorse amyloid-targeted therapies (such as the two that have been approved), but 41% remain skeptical due to previous failures and side effects. And only 5% of neurologists view biomarker changes (such as imaging or blood tests that measure amyloid plaque reduction) as a measure of clinical benefit.
The divide among neurologists also extends to the use of blood biomarkers for diagnosing Alzheimer's before symptoms appear. While this approach could enable earlier intervention, it also raises questions about the reliability of these biomarkers and the ethics of treating asymptomatic individuals. This division highlights the urgent need for solid evidence showing the reliability of beta-amyloid biomarkers in Alzheimer’s diagnosis and treatment.
As we move forward, it's crucial that we redirect our efforts towards understanding the early stages of Alzheimer's and developing interventions that can prevent or slow the disease before significant damage occurs. This may involve lifestyle interventions, novel therapies targeting earlier stages of the disease process, or a combination of approaches.
The current debate in the neurological community serves as a wake-up call. While new treatments offer hope, they also highlight the need for a paradigm shift in how we approach Alzheimer's disease. By focusing on early diagnosis and prevention, we may be able to make more significant strides in combating this devastating condition.
https://www.statnews.com/2024/07/28/survey-shows-neurologists-split-prescribing-anti-amyloid-therapies/
